目的 探究艾司洛尔对全身麻醉气管插管和拔管的心血管反应的影响。

方法 前瞻性选取进行气管插管全身麻醉择期手术的61例病人作为研究对象，按照简单随机数字法分为对照组（ n =31）和观察组（ n =30），对照组给予常规全身麻醉，观察组在常规麻醉前后缓慢注射艾司洛尔1 mg/kg。分析2组病人麻醉前（T ₀ ）、气管插管前（T ₁ ）、气管插管后即刻（T ₂ ）、气管插管后3 min（T ₃ ）、拔管前（T ₄ ）、拔管后即刻（T ₅ ）、拔管后3 min（T ₆ ）7个时点的收缩压（SBP）、舒张压（DBP）及心率（HR）的变化，T ₀ 、T ₃ 、T ₆ 时血浆肾上腺素（Ad）和去甲肾上腺素（NA）水平变化，以及围手术期不良反应发生情况。

结果 重复测量方差分析结果显示，SBP、DBP、HR时间因素及时间因素和分组的交互作用均有统计学意义（ P < 0.01）；事后多重比较显示，2组病人T ₁ 时SBP、DBP、HR水平低于T ₀ 时（ P < 0.05），T ₂ 、T ₃ 时SBP、DBP、HR水平高于T ₁ 时（ P < 0.05），对照组T ₅ 、T ₆ 时SBP、DBP、HR水平高于T ₄ 时（ P < 0.05），观察组仅T ₅ 时HR水平高于T ₄ 时（ P < 0.05）。组间比较显示，观察组T ₂ 、T ₃ 时SBP、DBP、HR水平低于对照组（ P < 0.05），T ₄ 时HR水平低于对照组（ P < 0.05），T ₅ 、T ₆ 时DBP、HR水平低于对照组（ P < 0.05）。重复测量方差分析结果显示，Ad、NA时间因素及时间因素和分组的交互作用均有统计学意义（ P < 0.05~ P < 0.01）；事后多重比较显示，观察组病人T ₃ 、T ₆ 时血浆Ad、NA水平均低于对照组（ P < 0.05）；对照组病人T ₃ 、T ₆ 时刻血浆Ad、NA水平明显高于T ₀ 时（ P < 0.05），观察组T ₀ 、T ₃ 、T ₆ 时血浆Ad、NA水平差异均无统计学意义（ P >0.05）。对照组拔管期呛咳的发生率为77.42%，明显高于观察组的43.33%（ P < 0.01）。

结论 艾司洛尔可有效减轻全身麻醉气管插管和拔管的心血管反应，且安全性较好，值得临床推广。

Objective To investigate the effects of esmolol on cardiovascular reaction caused by endotracheal intubation and extubation in general anesthesia patients.

Methods Sixty-one patients scheduled by operation with endotracheal intubation were divided into the control group(31 cases) and observation group(30 cases) according to simple random number method.The control group was treated with routine general anesthesia, and the observation group was slowly injected with l mg/kg of esmolol before and after conventional anesthesia.The systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) before anesthesia(T ₀ ), before endotracheal intubation(T ₁ ), immediately after endotracheal intubation(T ₂ ), after endotracheal intubation(T ₃ ), before extubation(T ₃ ), immediately after extubation(T ₅ ) and after 3 min of extubation(T ₆ ) were analyzed in two groups.The serum levels of epinephrine(Ad) and norepinephrine(NA) at T ₀ , T ₃ and T ₆ , and occurrence of perioperative adverse reactions were detected in two groups.

Results The results of repeated measurement ANOVA showed that the differences of the interaction of SBP, DBP and HR at time factor, and time factor and grouping were statistically significant( P < 0.01).The results of multiple post-mortem comparisons showed that the levels of SBP, DBP and HR in two groups at T ₁ were lower than those at T ₀ ( P < 0.05), the levels of SBP, DBP and HR in two groups at T ₂ and T ₃ were higher than those at T ₁ ( P < 0.05), the levels of SBP, DBP and HR in control group at T ₅ and T ₆ were higher than those at T ₄ ( P < 0.05), and the level of HR in observation group at T ₅ was higher than that at T ₄ ( P < 0.05).The results of comparison among groups showed that the levels of SBP, DBP and HR in observation group at T ₂ and T ₃ were lower than those in control group( P < 0.05), the level of HR in observation group at T ₄ were lower than that in control group( P < 0.05), and the levels of DBP and HR in observation group at T ₅ and T ₆ were lower than those in control group( P < 0.05).The results of repeated measure ANOVA showed that the differences of the interaction of Ad and NA at time factor, and time factor and grouping were statistically significant( P < 0.05 to P < 0.01).The results of multiple post-mortem comparisons showed that the levels of Ad and NA in observation group at T ₃ and T ₆ were lower than those in control group( P < 0.05), the levels of Ad and NA in control group at T ₃ and T ₆ were significantly higher than those at T ₀ ( P < 0.05), and differences of the levels of Ad and NA in observation group among T ₀ , T ₃ and T ₆ were not statistically significant( P >0.05).The incidence rate of cough during extubation in control group(77.42%) was significantly higher than that in observation group(43.33%)( P < 0.01).

Conclusions Esmolol can effectively relieve the cardiovascular response caused by tracheal intubation and extubation under general anesthesia, has good safety, and is worthy of clinical popularization.